Laserfiche WebLink
Burnett County Office of Zoning Administrator / -- z <br /> J o <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3 <br /> TO THE ZONING AUMINISTRATOR. The undersigned hereby makes application for a Permit for the work described and located as o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Usec <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of�7e State of Wisconsin. o- ;t\ <br /> c? .N. .......8........ .or..m..BW........................... . .....�1 fS..... ovJS =... .a......e .ta..�.0a..... N <br /> OWNER (please print) CONTRACTOR or SURVEYOR or AGENT a i^ <br /> .........5.5..9.........vJar..W...1! .................................. . . . . . . ............................................................................... a <br /> ADDRESS <br /> 5 <br /> ADDRESS <br /> "DR"E <br /> SSQ4w (� rN .........., <br /> ADDRESS ................. ?; p <br /> i <br /> €� <br /> ADDRESS <br /> ........................................................................................... .P..HONE ' <br /> ......................................................................................... :1 <br /> PHONE <br /> P..L..U...M..B..E..R............ .. . . . . ....... .............W..ELDRIttjLL.QER.......... .... ............. ........... ......... ...... ............................................................ <br /> i <br /> ............. . ............................................................... <br /> ADDRESS ............................................................................................ O :� <br /> ADDRESS nL <br /> . . .................................................................... .PHONE................................................................................ 0 <br /> 0 <br /> PHONE <br /> H <br /> DESCRIPTION z <br /> 4. Sanitary Facilities: ° o ° : <br /> 1. Work: X 2. New Building Details No. Bathrooms ....'-.:. , <br /> New Building ,,,,,,, Ty a of or�stru tion: No. Bedrooms a :W <br /> Addition ..,•,••,•, ..• ,�,.�( (p, 0.YAyR., Septic Tank Size Gals. <br /> ... 1 i <br /> Sanitary Size ..222...... ft. x ..1. ft. ••���� " <br /> Filling/Grading . .. Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving . Soil T ' <br /> .......... Area ........................................... Type .................................. . <br /> 0 <br /> • o <br /> Mobile Home ...—... Slope ....................................�... ., <br /> Privy3. Use (describe exactly, i -family Perc. Rate ............................. <br /> Well .. ... hom gar ge motel, etc.) Dry Well .......... -'s <br /> Subdivision — �r9 $ Seepage Trench ... i <br /> Camping Unit „• Priv ... .. , <br /> P g <br /> _______ Seepage Bed <br /> ---------------------------------------- .N <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig A. Include road <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter a <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING ruV 5 <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> o' <br /> A. . Location: <br /> 5. Lot Size: Fig. A6 :n <br /> ft. x .............. ft. — ............................... sq. ft. ............................................................................... :A <br /> IV �1 LV �SU1Wd <br /> N o. <br /> J J <br /> J <br /> � 5 79 <br /> 0 <br /> :O o <br /> r S v <br /> CX�stLIP- <br /> Y' 5 Z z <br /> 33 1 d :' o <br /> Plot ov5e- G.f��e A <br />�• `�;v <br /> r d � fd <br /> n y,tra < m � _. F <br /> SfINItOPy t t m. vaC� = ' n <br /> � <br /> D T c m c m <br /> M D n o � 0 m <br /> ro 3 <br /> —Aa3�tvt�e Zz9ftd _-.._ ?1 o m <br /> � cu ................... .....>.a.. .�S..-Ss.......... �,; <br /> _ . <br /> m <br /> Signature o Owner or Agent Date ° C <br /> X <br /> Remarks .................................................................................................................... „ m <br /> ........................................................................................................................................................................................ <br /> ...................................................................................................... ....... . ........ .. .... ...................................................................... <br /> Inspection Date ....................................... <br /> scr <br /> q: <br /> dT <br /> .............. ............. ....... . ..... y. tZon.n rt <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not lie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />